الفهرس 
ANATOMY OF ERECTOR SPINAE MUSCLEOnly 14 pages are availabe for public view
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Abstract
M
ajor abdominal surgery can cause significant post-operative pain and stress. Thoracic epidural analgesia (TEA) remains the gold- standard in its management. However, it is not without side effects or potential risks. Regional techniques might offer an alternative when thoracic epidural analgesia (TEA) is not possible. The ideal block choice in major abdominal surgery is not currently clear, therefore, this narrative review aims to summarize the relevant evidence and aid decision making for anaesthetists.
Post-operative pain associated with colorectal surgery is considered neuropathic and requires a multimodal treatment approach to achieve effective pain control with fewer side effects. Pain management is an integral part of Enhanced Recovery After Surgery (ERAS). After laparoscopic colorectal surgery, non-steriodal anti-inflammatory drugs, gabapentinoids, intravenous patient- controlled analgesia (PCA), central analgesic interventions, local infiltration analgesia, and regional blocks are usually performed for the control of the postoperative pain.
The aim of this study is to test the efficacy of ultrasound guided erector spinae plane block versus ultrasound guided oblique subcostal TAP block as regards its efficacy, hemodynamic stability, onset of post-operative pain, amount of post-operative narcotics used.
In the current study, forty patients scheduled for elective laparoscopic colorectal surgery received general anaesthesia were included. Patients were divided randomly into two groups, each group includes 20 patients.
group T: Patients in this group received ultrasound guided OSTAP block after induction of general anaesthesia.
group E: Patients in this group received ultrasound guided ESP block after induction of general anaesthesia.
As regard the analgesic parameters recorded in the current study; the NRS was significantly lower in group E (ESP) block when compared with that of group T (OSTAP) block and showed significant difference between both groups at 4, 6,8 and 10 hrs postoperatively.
Also, time to rescue analgesia, there was clinically and statistically highly significant longer time to ist rescue analgesic in group E (ESP) block was 15.68+1.50 hours compared to that of group T (OSTAP) block was 9.56+2.41 hours. These findings were in an array with a case series done by Luis-Navarro and his colleagues who reported that the first rescue analgesic was required only at 16 hours after ESP block.
In the current study, total meperidine consumption with the mean total consumption in each group was 75+0.37 mg in the ESP block group compared with 125+0.87 mg in the OSTAP block group there was highly statistically significant higher mean of total analgesic consumption in group T compared to group E.